Health Care: 10 tips for a better hospital stay

Patient Power

By Anna Zernone Giorgi/HealthyLife

Anticipating a trip to the hospital doesn’t have to mean increased anxiety on top of whatever’s ailing you.

Taking an active role in your care can help to ensure a positive hospital experience. With some smart preparation, you can feel confident that you’ve done your best to create a situation that will lead to a speedy and healthy recovery. Read on for 10 steps to make that happen.

“Staffing of the hospital is based on 24 hours, seven days a week and we must maintain the same standard of care day/night, weekend or holiday.”— Renee Mauriello

1. Do Your Homework

Before you pursue treatment for a medical condition, consider what hospital your potential health care provider uses. You’ll be at a loss if you develop a trusted relationship with a physician who is on staff at a hospital with which you’re not satisfied.

“If you know that procedures and surgeries are going to be in your future, choose the hospital that has the lowest number of infections and the highest patient satisfaction scores. First, choose the hospital; then find out what doctors have admitting privileges there and make sure your insurance covers the physician and the hospital,” advises Trisha Torrey, Every Patient’s Advocate, author, speaker, and guide to patient empowerment at About.com.

Finding a hospital you’ll feel confident using may be easier than you think. You can investigate comprehensive performance data on websites such as New York State Hospital Report Card, New York State Hospital Profile, and Hospital Compare. You also can use the sites to review outcomes and treatment data for specific procedures and patient satisfaction surveys.

2. Plan Your Itinerary

When your physician recommends a hospital treatment or procedure, you’ll be more comfortable if you know as much as possible about where you’re going and what will happen when you get there.

“I always say that planning a trip to the hospital is like planning a vacation; we should take the same level of care and due diligence in planning a trip to the hospital. I know the thought of going to the hospital can be overwhelming, but remember, if you have planned a vacation, you can plan a trip to the hospital,” says Beth van Bladel, founder and director of Capital Region Patient Advocacy, a grassroots endeavor dedicated to teaching health care advocacy and navigation skills to the community.

Before you go, pack photo identification, insurance cards, and copies of advance directives. But, leave your valuables at home. Worrying about them will distract you from concentrating on more important issues.

Part of your planning will include selecting the best time to have your procedure or treatment. Your choices may be limited by your medical needs, the availability of the equipment and personnel needed for your procedure, and the specific days on which your surgeon schedules time at the hospital.

You’ll also want to consider your own schedule, time needed for hospitalization, and recuperation. Having major surgery on a Friday or the day before a holiday may mean that your surgeon and other specialists will only be available on call instead of being there in person. If this is a concern, clarify issues related to your surgeon’s accessibility and the continuity of your care.

“In general, elective surgery is scheduled during periods of time when we have the kind of people and kinds of equipment that we need for that patient,” says Mary Jo LaPosta, Ph.D., senior vice president of patient care and organizational excellence; chief nursing officer, Saratoga Hospital.

If you’ll be using a teaching hospital, part of your daily care likely will include interaction with in-house medical residents. Typically, a new class of medical residents takes over in early July. If this is a cause for concern, talk with your surgeon about scheduling options. Know that you have the right to select a time that’s comfortable for you and if it’s not, “Just say, ‘No,’” Torrey says.

3. Appoint a Health Care Representative

One of the most important ways to manage your hospital experience is to appoint a health partner for the duration of your stay. Your health partner also can serve as another set of eyes, ears, and hands to look out for and help with any problems. “Have someone at your side at all times 24/7. You may have to go to the bathroom 24/7. You can fall if you get out of bed 24/7,” Torrey says.

Your health partner can be a loved one, a friend, neighbor, or professional patient advocate. “It’s very important to bring ‘travel companions’ with you to the hospital. They can offer moral support and advocate for you,” van Bladel says. “Make sure the hospital has the necessary paperwork on file so that your travel companion has the right to be informed about your medical condition and care needs.”

To ensure that your companion can advocate for you, you’ll have to complete a health care proxy. The New York Health Care Proxy Law gives you the right to appoint another person to be your health care agent. By assigning a health care agent, you give that person the right to make your health care decisions if you are unable to do so yourself.

Anyone can be your health care agent. You also can change and reassign your agent at any time. The health care agent’s authority is only applicable in situations in which you are unable to make decisions for yourself.

“It’s very important that every patient has a health care proxy — no matter what age you are or how healthy you are,” says Cindy Lisuzzo, RN, director of care management at Saratoga Hospital. “So many people don’t have a health care proxy because no one thinks they’re going to need it.”

A health care proxy differs from a living will. A living will allows you to indicate your instructions regarding health care and end-of-life choices in writing. Your health care agent can carry out the wishes of your living will. However, you have to use a health care proxy to name your health care agent.

If you have more than one health partner or travel companion, make sure each one can have access to your medical condition and needs, even though only one will be your health care agent. This likely will require that every companion is listed on your HIPAA (Health Insurance Portability and Accountability Act) Form.

4. Keep a Journal

One of the most important ways to keep control over your hospital stay is to maintain a journal. Ideally, this will contain contact information on the doctors you’re seeing, the medications you’re taking, and procedures performed. You should begin keeping this journal at your doctor visits and pre-admission appointments.

“Ask your travel companion to bring a notebook and pen to maintain a log of your hospital health team visits,” van Bladel advises. “Write down the names and titles of all the doctors, nurses, and aides who come in to visit you and describe the procedures they are performing. Ask the companion to keep your health team informed as they change shifts [for continuity of care].”

The journal can be helpful if you have more than one travel companion. As your travel companions “change shifts,” each one can be updated on your care.

5. Help Minimize Mistakes

Hospitals, like any other institution or workplace, are subject to human error.

Some of the most common hospital mistakes occur during the medication process. Errors can happen at the time of prescribing, dispensing, and administering. In a 2006 report by the Institute of Medicine, the group reported that, “When all types of errors are taken into account, a hospital patient can expect on average to be subjected to more than one medication error each day.”

While it’s important to note that this statistic is an average and errors vary widely among different facilities, you and your health partner can work to prevent mistakes that could jeopardize your care and prolong your stay. To do this, carefully check that the information on your wristband is accurate. Always double check any medication that is administered, including those in intravenous (IV) lines or topically. It’s important to note the prescribing physician as well as the medication’s name, dosage, purpose, and potential side effects.

To avoid wrong-site surgery, insist that the correct site is marked clearly. Before you receive sedation or anesthesia, you and your health partner should confirm that the appropriate site is indicated with a marker by your surgeon. Ultimately, it’s the responsibility of your surgeon to ensure that the correct site is treated, but it’s you who will live with the consequences.

Photo: (c) Marcus Lindstram/GettyImages.

6. Protect Against Infection

While you’re a patient, you’ll also have to be vigilant about protecting yourself against healthcare-associated infections (HAIs). HAIs can make you sicker than when you arrived at the hospital, add days to your hospital stay, and cause long-term complications. In extreme cases, they can be fatal. According to the Centers for Disease Control and Prevention (CDC), approximately one out of every 20 patients will contract an HAI while in the hospital.

You and your health partner can take the lead in minimizing the presence of germs. Diligent hand washing, using the antibacterial soap provided by the hospital, is the first place to start. Insist that everyone who enters the room, including visitors, wash their hands as soon as they enter. “Patients should feel very comfortable saying to the doctor, nurse, or physical therapist, ‘I need you to wash your hands before you touch me or anything around my bed,’” LaPosta says.

Since germs can live on any type of surfaces, don’t be afraid to do a little housekeeping in your own room. “Take some disinfectant wipes with you and wipe down the remote and the door handle. Do it each time someone new comes in,” Torrey says. “It’s up to you as much as the hospital to keep germs from getting into your incision.”

You also can minimize infections by covering your cough with a fresh tissue and monitoring places where germs can enter your body. “If any of your dressings are loose, or appear to have increased drainage, tell your nurse who will assess for any signs of infection,” says Tracy Blowers, Director of Service Excellence at Ellis Medicine in Schenectady. “Intravenous and drains also can be an entry point for infections. If your dressing is loose, or if the area appears red or has increased tenderness, tell your nurse.”

7. Manage Your Care

It’s also important to understand who is overseeing your medical care while you are a patient. Typically, you’ll have a variety of different specialists, other physicians, and nurses that will change during the course of your care. “You have a right to ask, ‘Who is the physician who is coordinating my care?’ And, you have the right to hold that physician accountable,” LaPosta says.

Once you identify the coordinating physician, you should have the opportunity to discuss any decision regarding your care with that physician. While the coordinating physician may not be your primary care physician when you are in the hospital, you should ensure that he or she is kept informed of your condition. “Even when there is a specialist coordinating your care, patients should feel free to touch base with their primary care provider who should know them better than anyone else and be able to discuss major decisions with them,” LaPosta says.

Since medication errors can occur easily, it’s also important that you take the lead in making your hospital team aware of any current prescriptions and past drug reactions. This information is critical to avoiding reactions and interactions with new prescriptions, IV medications, and anesthesia.

“You should always have a list of the medications you are taking, including the name of the medication, the date, from whom it was ordered, why it was ordered, and why you were taken off it. This lifetime medical list should include any dietary or herbal supplements, as well as over-the-counter drugs,” LaPosta advises.

8. Don’t Be Afraid to Speak Up

No matter how well-prepared you may be, problems can arise. When they do, it’s your right and responsibility to notify your medical team. If you are unable to do so, it’s up to your health care agent. “The patient [or a family member or friend] absolutely needs to advocate for himself. If there is something that doesn’t make sense or something that the patient does not agree with, it’s important to ask for more information or for clarification,” Blowers says.

If you don’t feel you’re getting resolution from your medical team, contact your hospital’s patient representative or patient advocate. His or her name likely is included in your hospital information packet.

If you feel the situation is critical, find out if your hospital utilizes Condition H (for Help). A Condition H response is similar to that of a rapid response team. When a Condition H is activated, a team of hospital professionals will rush to the patient’s bedside to assess the situation and intervene if necessary. “Condition H is a hotline that patients and their families can call if they ever feel the patient is not receiving adequate medical attention,” Blowers says. “Condition H was established to improve the quality of communication between families and caregivers, and to provide safeguards for families when they believe a loved one’s health is in jeopardy.”

When cases remain unresolved or to file a complaint, contact the New York State Department of Health.

9. Follow Through with Follow-up

When you are ready to be discharged, it’s important to get your instructions in writing. Your health partner should be with you to help clarify any possible confusion. Get written instructions about the signs and symptoms that indicate you are getting better, the signs and symptoms that warn you are getting worse, and whom to contact if you have a problem or questions.

“Fundamentally, patients need to be sure they understand the discharge instructions and absolutely let the case manager or whomever is handling the discharge know if you do not,” Blowers says. “Patients often get readmitted because they are not compliant with the discharge plan. However, the reality is, folks often don’t understand the instructions or are unable to follow through due to financial reasons (i.e. certain medications may be too expensive).”

Consult with your health partner about the logistics of getting to follow-up appointments and tests. “Before they leave the hospital, patients should have actual appointments for when they are going to see the doctor, what the doctor’s name is, what their specialty is, and where their offices are,” LaPosta says. “So many patients do not do that.”

It’s also important that you and your partner review your medication needs. If possible, fill any prescriptions on your way home from the hospital to avoid any lapse in dosage. “Ask for a medication reconciliation so you will understand the medications to be continued at home and how to develop a safe and effective routine,” van Bladel says.

10. In Case of Emergency

If your visit to the hospital is unplanned due to an immediate need for help, your experience may depend on variables over which you have no control. The very nature of needing emergency care may mean you are suddenly immobilized or unconscious. Preplan by having a signed health care proxy and living will, so that others can intervene on your behalf. Ensure that your health care agent has copies of these documents, your identification, and insurance information.

If you’re awake and aware, it will help to understand that emergency treatment is based on the triage system, which differs from other types of hospital treatment. “Triage always treats the most dire emergency first,” Torrey says. “If there are a lot of people there, and the hospital is short-staffed, you’re going to keep moving down the list if you go there with something that really isn’t dire.”

In the emergency room, the same rules apply with regard to the importance of having a travel companion or health partner. If you go there alone, ask a companion to meet you there if your health care agent isn’t available.

Since your care may take longer than expected, make sure you understand the reason for delay. If you are neither released nor admitted after receiving treatment, ask about your status. You may be assigned “observation status.” “If a patient is assigned ‘observation status,’ then he is considered to be an ‘outpatient,’ meaning he is not admitted to the hospital,” Torrey says. “Some insurances, including Medicare, don’t consider observation status as an admission and, therefore, don’t cover the cost.”

As with an inpatient visit, keep a journal of your emergency room experience so you can follow up with your own physicians and settle any insurance conflicts that may arise after your visit.